Transcript Kaiser Update February 2005

Kaiser Update
March 2005
Northumbria/Northumberland
Integrated network of emergency
care services – By day
Emergency
Care
We have been interested in
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Long Term Conditions
Care Facilitation-Interqual
Contact Centre
Buildings
Impressed by
– Culture
– Use of Information
The Kaiser Triangle
Case management
Complex: co morbidity
High resource use
Case manager navigator
and support usually
telephone
Care management
More intensive
management
High risk
Group education
Supported Self
management
Good control
Routine medical
review
Risk stratification
Population wide prevention
Primary
Care
Educated Patient & Carer
Community
Teams
Whole System Planning & Delivery-3Rs
Chronic Disease Objectives
Expensive,
Reactive,
Unplanned Care
Effective Chronic
Disease
Management-3Rs
Effective,
Responsive,
Anticipatory
Structured Care
Patient
Empowered
Care
Planning
Bob’s Pearls of Wisdom
• The NHS will not be as successful for
patients as it needs to be, as long as we
still see ourselves as either primary care
or secondary care
• What can we do about our structural
boundaries?
Northumbria
Board
CT Brd
PEC
Priority and
Decisions Group
(PDG)
CPG-Clinical Policy
Group
Clinical Carestream Leads
Carestreams
Clinical Director &
Locality Manager
Care Streams
Professional Leads
Clinical Team Leads
Clinical Directorates
Primary care based
commissioning
SW
PHCT
PHCT
Clinical Directors
PMS
Wards
Departments
CT Brd
Successful Whole System
Service Delivery
Northumbria
Board
PEC
Priority and
Decisions Group
(PDG)
CPG-Clinical Policy
Group
Clinical Carestream Leads
Carestreams
Clinical Director &
Locality Manager
Clinical Directors
Professional Leads
Clinical Team Leads
Clinical Directorates
Primary care based
commissioning
SW
PHCT
PHCT
PMS
Wards
Departments
‘Reid unveils new changes to
LTC Care’ – 5th January 05
• Major overhaul of the in the way care is
provided to patients will LTC
• Organisations will
– Community Matron
– Identify people with LTC, 3 Rs
– Educate patients with LTC
• National Service Framework (NSF) for
Long Term Conditions will be published
later this year
LTC-Launch event
• Clear statement of intent-Aims
• Clash of Views
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Generalist Vs Specialist views
‘My Service’ or ‘The Service’
Out of ‘site’, out of mind
Heard this all before
• Boundaries are still a problem
• Management
– Organisation vertical/Network horizontal
– Capacity-numbers, skills and attitude
– Permission and AUTHORITY
• Leadership Capacity
• Engagement - Still a problem
Managed Clinical Networks
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Whole system and responsible for the full pathway
Bring to the table ‘the Assets’-and AGREE the plan
Clear Freedoms -Could be beyond ‘the unthinkable’
Fences -What is inside the fence (within the gift)
Decision by agreement then have to deliver it operationally
Statements of roles and responsibilities, freedoms and fences
Clinically led but populated by the right input from the ‘coalface’
Information jointly owned and shared to inform the planning and
decision making processes
• Operationally accountable through the original organisations but
jointly responsible through the partnership planning process
• Requires Leadership, Engagement, Management
Long Term Condition Partnership
Board-Manage the Cross-cutting
themes
• Added value
• National and local
priorities and targets
• Education and Training
opportunities
• See the whole picture
• Give guidance and
direction to LTC streams
• Cross stream Learning
• Relative and comparative
risk management begins
• Apply common models
• User and public
involvement
• Patients with complex
and multiple conditions
• Senior clinical and
managerial level input
LTC-PB
M/Skel CVS
DM
Older
People
Stroke
GI
Pall Care
RESP
Chronic
Neuro
Rheum
OA
O/porosis
Pain
Cancer !
DM
Resp
M/Skel
GI
CHD
Stroke
Managed Clinical Networks
Cross-Cutting Themes
Use of Information
Medicine
Case
E&T
Management
Management
Original Management Structure
N’umbria G.M.
and Director
N’umbria
OSM
Care Trust
Directors
Care Trust
Managers
Department
Managers
Care Trust
Staff
Ward or other
management
First Stages
Director for LTC
N’umbria Director
?Later
CT Director
Network Manager
Changed
N’umbria OSM
Role
Wards or
Departments
Changed CT Manager
and GMs Role
Primary Care
CT Staff
Existing Structure-(Medical and
Emergency Only)
Northumbria
PCOs
Access
Prim care
Urgent
Care Brd
14 Care
streams
CIDAR
MOB
ECOB
Wider Context
Care Trust &?PCT
Northumbria
Medicine &
Emergency
care Board
Northumberland
Urgent care
Carestream
Long Term
Conditions
Partnership
Board-LTCPB
Primary Care
Access/
Comm Service
Change in Style
Secondary care
Primary care
D
D
1999
Primary care
Secondary care
Specialist care
Supporting
and managing
quality diabetes
care
2002
Achievements in North Tyneside
1991 -2001
•Structured Care District wide 97%
•Biomedical measurements
80 – 97%
•Satisfaction with care
84 – 95%
•Sustained
for 10 years
also
•Reduced amputation rate / Reduced bed occupancy
All measures equal to those achieved in the UKPDS
but with routine care – a majority within primary care
Respiratory Services-Winner of
National Award for LTC
• Individualised assessment, in hospital,
outpatient clinic and at home
• Promoting self care and independent living
• Enabling people
• Evidence based
– Research and audit
– User experience and views
– Collaboration with health professionals, internal
and external
Results and Quality
• Outreach
– 43% reduction in readmissions
– Reduced admission into nursing or residential care
– 70% improved breathing control
• Supported discharge
– Median length of stay 4 days
– 5% readmission rate
– 8% length of stay 1 day
Phase 3
An Update for Kaiser
Contact Centre Development Plan
Elective
Care
2003
2004
2005
2006
NT
outpatients
Core outpatients
WLI inpatient lists
Pre-Op screening
Choose & Book
Capacity scheduling
GSUPP & CAPIO
50% Inpatient
Booking
Emergency
Care
Physio
Line
Pathway for
18 week
target
Respiratory
CRM Pilot
Gynae
booking
Family
Care
Diagnostic
Services
Choose & Book
Diagnostics
Support
Services
Teams &
Facilities
2008
Emergency
Outpatient
Appointments
Bed
management
Chronic
Disease
2007
Phase 1
Old Payroll
8 admin staff
Staff Care Advisors
IT helpdesk
NT Auto Switch
Switchboard
Recruitment
Digital Dictation
Phase 2
Board Room
25 admin staff
Phase 3
Balliol
45* staff
Capital
Cost
£20k
£120k
Revenue
Cost
£0k
£0k
Foundation Customer
Relationship
Management
Phase 4
Balliol + 12 Home Workers +
Diagnostic & Therapy satellites
£300k
-£100k
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Core Contact Centre
• Now doing 15,000 calls per month
• Move to ‘proper’ contact centre this month
– 50 seats (currently have 19)
– Training and distribution facilities
• Integrating switchboard in April so we have 24/7
service and a one stop number for all services
Physio Line Contact Centre
• Currently patients wait up to 8 weeks for first
appointment with physio
• New pilot with 4wte clinical staff (physios) on the phones
• Taking calls from musculoskeletal patients attending their
GPs in Whitley Bay and Central locality
• Aim for full phone review by physio within 48 hours using
e-tools created within trust
Physio Line Contact Centre
• Physio will assess patient and decide how to proceed…
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Advise and discharge
Advise and follow up by phone
Book into appropriate appointment
Stream ‘red flags’ to appropriate location
• Aim to manage 60% patients without need for face to
face appointments
• Full Northumbria roll out would take 10wte physios
• If all goes well we hope to extend Physio Line to other
clinical professionals and specialties
Digital Dictation &
Speech Recognition
• In Kaiser Atlanta we saw same day
automated documentation production
• We have delays of up to 6 weeks and
spend over £1million per year on typing
alone
• We recognised the potential for us…
Digital Dictation &
Speech Recognition
• We have appointed a supplier and commence
pilot March 2005
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Same day document production
Letters for patients while they wait
Discharge letters emailed to GPs same day
All hospital correspondence available electronically to
all staff
• Aspire to make 80% reduction in typing backlog
and 40% efficiency savings
Care Facilitation- Use of
Interqual
What is care facilitation ?
• Clinical Decision Support Software
Introduced
– Aim for the Right patient in right bed all of the
time with shortest hospital stay
– Used software to tell us what beds we need
• Patients’ journey facilitated by teams of Care
Facilitators
Strengthening Back of House:
Care Facilitation
• Interqual used to check that patients are
receiving the right level of care for their
needs
• Software used to assess care needs on
admission, continued stay and safe to
discharge.
• Ensures that patients are not receiving to
low or to high a level of care
Care Facilitation Admission Review
Results
10.10%
N = 7,206
4.90%
5.60%
26%
18.70%
2.90%
2.90%
23%
4.30%
51%
46.30%
Observation
Acute
Wrong
Acute
Homecare
Long Term Care
Observation
Outpatients
Residence
Skilled Nursing Facility
Skilled Therapy Facility
No ALOC Entered
Critical Care (Intensive / Coronary)
Intemediate (HDU)
Of the total occupied days for the patients
followed by care facilitators, most were at an
inappropriate level
31,441
days
0%
20%
10,300
days
40%
60%
15,794
days
80%
100%
Inapropriate use of acute bed day due to level of care not available
Inapropriate use of acute bed due to service delays
Appropriate use of acute bed
As well as giving us data,
Care Facilitation is enabling us to cope
65019
28049
60274
24402
58090
23507
Admissions are up
Outpatient Referrals are up
1455
21%
16%
1423
1395
4%
Beds are down
Fewer Medical patients in surgical beds
What Interqual tells us we need to do…
• re-designate our hospital beds
• sort out timely diagnostic and therapy
support
• actively medically review the sickest
patients
• focus on levels of care for the avoidable
admissions
What else are we interested
in?
Culture, culture, culture
Customer satisfaction matters – this requires personalised care & real choices
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Performance based on patient satisfaction
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Behaviours are based on the organisational values
Used as part of recruitment process
360 degree appraisal (team and patients)
Performance management
• Incentives and exit strategy
– Process improvement
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Whole systems leadership & OD programs
Behaviours based on values
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Concentrating on the customer
Recruiting with the customer standards in mind and moulding people to be ‘our
people’
360 degree involving patients
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Real information is key
• Whole system health information used to allocate
resources
• Information is used as the basis for all decision
making
• What we have done today, not last year
• Real time information about demand, capacity,
activity, and backlog
What we would like from KP
• Skills for
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using information,
moulding behaviours,
improving performance
changing the culture
Systems change
• Experience of KP people working with our teams
– Medical staff using care facilitation
– Support developing Integrated contact centre
– Job swap or Shadowing equivalent Kaiser Staff eg Chief
Exec, Med Director, Senior Exec